# AVITA DRUGS OREGON, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Avita Pharmacy 1078
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760250567
- **Authorized official:** ASHLEY ELLIS (CORPORATE COUNSEL)
- **Authorized official phone:** (704) 641-7967

## Contact information

- **Practice address:** 15 N MORRIS ST STE A, PORTLAND, OR 97227-1541
- **Practice address phone:** (469) 592-2011
- **Mailing address:** 10604 COURSEY BLVD, BATON ROUGE, LA 70816-4015

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 12/12/2023
- **Last updated:** 12/12/2023